PURPOSE: A laparoscopic cholecystectomy is now the gold standard for the treatment of gallstone disease. While the widespread use of ultrasonography has increased the frequency of the diagnosis of polypoid lesions of the gallbladder (PLG), no optimal strategies for evaluating and treating these lesions have been established. The aims of this study were to identify the risk factors for malignancy, and evaluate the usefulness of laparoscopic cholecystectomy for PLG. METHODS: The clinical and histopathological data from ninety PLG patients, who received a laparoscopic cholecystectomy, between January 1998 and December 2005, were retrospectively analyzed. Data were evaluated using a multiple logistical regression analysis. RESULTS: There were 82 benign PLG, including 38 cholesterol polyps, 22 adenomas, 18 hyperplastic polyps and 4 adenomyomas, and 8 malignant PLG. The average age of the patients with malignant PLG was significantly older than that of those with benign PLG (P=0.001). The average malignant PLG diameter was significantly larger than that of the benign PLG (P=0.000). The malignant PLG were mostly a single lesion; whereas, half of the benign PLG were multiple lesions. In the multiple logistical regression analysis, polyp sizes greater than 1.5 cm and an age over 50 years were the two most important factors for predicting malignancy of PLG. Seven of eight patients with malignant PLG are still alive at a mean of 43.8 months after surgery, and without any recurrence. CONCLUSION: The risk factors for malignancy were found to be the polyp size and patient age. A laparoscopic cholecystectomy can be considered an adequate treatment for patients with a stage I gallbladder carcinoma.